{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:43:41Z","timestamp":1792601021649,"version":"4.5.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100016545","name":"Roche Diagnostics","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016545","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009687","name":"Wroclaw Medical University","doi-asserted-by":"publisher","award":["IDUB.A46B.24.002"],"award-info":[{"award-number":["IDUB.A46B.24.002"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Loop diuretics (LD) are the cornerstone of congestion management in heart failure (HF), but whether their requirement can be reduced by optimizing disease-modifying therapy is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this post-hoc analysis of STRONG-HF (n = 1075 with post-randomization LD data), we assessed whether up-titration of guideline-directed medical therapy (GDMT) lowers LD demand, and whether LD dose reflects HF severity, predicts outcome, or modifies the benefit of high-intensity care. Patients were grouped by furosemide-equivalent dose; change at day 90 was compared by achievement of 100% target GDMT doses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Higher LD doses marked more severe HF. Achieving 100% of target doses of all GDMT classes (RASi, beta-blocker, mineralocorticoid receptor antagonist) translated into a substantially lower diuretic requirement: furosemide-equivalent dose at day 90 fell by \u221221.94 (SD 52.46) mg versus \u22121.55 (SD 49.886) mg in those not reaching targets (P &amp;lt; .001); beta-blockers showed the largest effect of any single class \u221218.42 (SD 49.61) mg, (P &amp;lt; .001). LD dose category was not independently associated with the primary endpoint (all-cause death or HF rehospitalization at 180 days) or its components; only LD dose doubling was associated with higher all-cause mortality (adjusted HR 1.47, 95% CI 1.04\u20132.09), without association with the primary endpoint or rehospitalization (both P &amp;gt; .05). The benefit of high-intensity care was consistent across LD dose groups (no treatment-by-dose interaction).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GDMT optimization acted as diuretic-sparing therapy: reaching target doses, particularly of all three classes, was associated with markedly lower LD requirement. LD dose mirrored HF severity but neither consistently predicted outcome nor modified the benefit of up-titration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejhf\/xuag309","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T08:24:35Z","timestamp":1791534275000},"source":"Crossref","is-referenced-by-count":0,"title":["GDMT is associated with reduced loop diuretic requirements, whereas diuretic dose does not modify GDMT benefit in heart failure: STRONG-HF"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9977-7722","authenticated-orcid":false,"given":"Jan","family":"Biegus","sequence":"first","affiliation":[{"name":"Department of Cardiology, Wroclaw Medical University, Faculty of Medicine, Institute of Heart Diseases , Borowska 213, Wroclaw 50-556 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,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4908-9758","authenticated-orcid":false,"given":"Christopher","family":"Edwards","sequence":"additional","affiliation":[{"name":"Momentum Research Inc , Durham, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelena","family":"\u010celutkien\u0117","sequence":"additional","affiliation":[{"name":"Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University , Vilnius ,","place":["Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ovidiu","family":"Chioncel","sequence":"additional","affiliation":[{"name":"Emergency Institute for Cardiovascular Diseases \u2018Prof. C.C.Iliescu\u2019, University of Medicine \u2018Carol Davila\u2019 , Bucharest ,","place":["Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Cohen-Solal","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, INSERM UMR-S 942 (MASCOT) , Paris ,","place":["France"]},{"name":"Department of Cardiology, APHP Nord, Lariboisie\u0300re University Hospital , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5640-0332","authenticated-orcid":false,"given":"Gerasimos","family":"Filippatos","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Novosadova","sequence":"additional","affiliation":[{"name":"Momentum Research Inc , Durham, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8272-0911","authenticated-orcid":false,"given":"Karen","family":"Sliwa","sequence":"additional","affiliation":[{"name":"Cape Heart Institute, Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianela","family":"Barros","sequence":"additional","affiliation":[{"name":"Momentum Research Inc , Durham, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0925-494X","authenticated-orcid":false,"given":"Albertino","family":"Damasceno","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Eduardo Mondlane University , Maputo ,","place":["Mozambique"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9298-7871","authenticated-orcid":false,"given":"Matteo","family":"Pagnesi","sequence":"additional","affiliation":[{"name":"Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadiza","family":"Saidu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Murtala Muhammed Specialist Hospital\/Bayero University Kano , Kano ,","place":["Nigeria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0213-1509","authenticated-orcid":false,"given":"Koji","family":"Takagi","sequence":"additional","affiliation":[{"name":"Momentum Research Inc , Durham, NC 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